1. Section Editor(s): Alexander, Mary MA, RN, CRNI(R), CAE, FAAN

Article Content

The most important feature of the nursing profession is that we hold our patients' lives in our hands. Our work saves lives and makes lives better. We are not only ethically required to deliver competent care but also legally responsible to do so, and we can be held liable for any harm caused by disregarding institutional or legislatively established standards of care.1 Institutions, too, can be held legally responsible for mistakes made by their employees. Nurses, however, are also personally liable for their actions on the job, making it essential that nurses be aware of risk-management strategies to protect themselves in case of a malpractice lawsuit.

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Infusion nurses can be particularly vulnerable to lawsuits because of the invasive nature of the specialty. When we make serious mistakes, our patients can lose limbs, their livelihoods, or their lives.


All nurses must be licensed to practice, with minimum requirements for licensure set by a state's board of nursing. In addition, each nurse must know the parameters of the Nurse Practice Act (NPA) in the state in which she or he practices. Each state has its own unique NPA; however, most contain provisions on scope of practice.1 Practicing outside the delineated scope of practice constitutes serious misconduct, and doing so can result in expensive indemnity.2


CNA HealthPro and Nurses Service Organization recently published an analysis of nurse-closed claims filed during a 5-year period. The authors cited the most common areas leading to claims:


* Patient assessment and monitoring. Nurses are expected to assess each patient to establish a baseline for monitoring reactions and response to therapy.3 Failure to do so can lead to a malpractice suit and a high paid indemnity.


* Treatment and care. These errors, which can encompass a large number of procedures, are most often related to improper or untimely management of aging services residents, failure to notify a practitioner of a patient's condition, or improper or untimely nursing management of medical patients or medical complications.


* Nurse and patient communication. Clear communication is critical to a successful nurse-patient relationship. Failure to establish effective communication can cause misunderstandings about treatment and, ultimately, poor patient outcomes.


* Timely and complete documentation. It is imperative that the nurse document accurate information about the patient's condition and care, and entries must be made contemporaneously. Records must never be altered or removed from the patient care unit.


* Chain of command. All facilities should have a chain-of-command policy, and every nurse must be familiar with it. When problems arise in patient care, the appropriate health care professional must be contacted immediately, and the nurse must follow through with the proper intervention.2



The popularity of social media presents a whole new set of privacy issues that may not yet be addressed by organizational policies but nonetheless can lead to lawsuits. Facebook and Twitter make it easy to post pictures without permission, reveal confidential patient information, or make inappropriate comments. Be sure you are following your organization's policy regarding the use of social media; if one doesn't exist, suggest creating one and consider being part of the team that develops it.


There are a number of methods, called risk-management strategies, that nurses can use to reduce the risk of potential liability. Although your organization should have risk-management checklists to help you cope, you should be aware of the types of issues that most often arise in lawsuits and assess yourself for potential problems.


Even if a facility carries malpractice insurance, many nurses purchase their own liability insurance to protect their personal assets in the event of a lawsuit. Given the relatively higher risk of personal liability in our specialty, it is in a nurse's best interest to purchase personal liability insurance. As nurses, we are always putting our patients and their care first; this is an instance when we need to think about our own welfare.


The author of this article has no conflicts of interest to disclose.


Mary Alexander




1. Alexander M. Legal issues of infusion nursing. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. St Louis, MO: Elsevier/Saunders; 2010:49-59. [Context Link]


2. CNA HealthPro and Nurses Service Organization. Understanding Nurse Liability, 2006-2010: A Three-Part Approach. Chicago, IL: Authors; November 2011. [Context Link]


3. Infusion Nurses Society. Policies and Procedures for Infusion Nursing. 4th ed. Norwood, MA: Infusion Nurses Society; 2011:10. [Context Link]

Thank You, Craven & Ober


On behalf of INS, I'd like to thank the authors of the Journal's IV P.U.M.P. column, Gloria Craven and Stacey Ober, for their invaluable contributions to this publication. This issue of the Journal includes the last of many IV P.U.M.P. columns, which have kept our readers informed of the latest legislation and regulations that affect all of us in our infusion therapy profession.


I wish Gloria and Stacey all the best as they continue to advocate for health care policy that works for both nurses and their patients.